Pts handpicking assignments, and refusing nurses of opposite gender?

[jdub6]

I'm an old lurker, new poster around here. Although I work in s specialty I'm posting this here because I think it applies to most nursing areas. This is a partial vent and partial request for input. How do you respond when female pts (or their families) refuse to have male nurses/aides involved in their care? Recently on my floor, we have had multiple (usually elderly) women refuse male nurses. If they can't speak, often the family says the same thing. Ditto with not wanting men involved in foley placements or hygiene care, transfers to bathroom/commode, etc.

Often, these patients are obese, require multiple staff for hygiene care, etc.

While I certainly understand the embarrassment they feel, I have never, ever, not once had a male pt insist on male caregivers. (Some say that men enjoy female attention, and this may be true for a few, but most seem just as embarrassed as the women. However, whether there are just so many more women than men in nursing that they haven't had the option enough to think to ask, or whether they just think of it more as a professionak relationship, I have never in 10+ years had an adult male ask for male only caregivers.)

There are some nurses on my floor who will move heaven and earth, make assignments that make no sense and try to do full bed changes on 500 pound women with diarrhea themselves because of these requests. Most don't even try to reassure the pt and see if they can work it out first, they believe these women have "a right" to choose the gender of their nurses. Personally, I think that preferences can be taken into account but not guaranteed, particularly when no one makes any effort to give male nurses to male pts. When there are only 3-4 staff on a busy floor and 2 are men, often you gotta use at least one man to help with the total care pts. And I see nothing wrong with using the same reassurance on the women than we use on the men, ie that we are licensed PROFESSIONALS doing our job, etc. (Not to mention that I.do believe facilities with CMS accreditation cannot be discriminatory when hiring, including gender discrimination)

In a similar vein, what do you do when pts do the "I only want nurse x, if she's not here then nurse y. And I hate nurses r, s, t, l, n and e and refuse to have then involved in my care." Occasionally one of the shunned nurses has done or said something worthy of a complaint, but I have heard reasons as benign as "when we asked if she worked days all she said was yes, and we don't like one word.answers."

So what are your thoughts? Does this happen frequently in your facility? Does the gender exclusion tend to always be female pts, like at my unit? Any strategies to resolve the gender concern without totally messing up continuity of care for others, not to mention throwing the fairness of assignments off balance. And do you allow pts to hand pick staff and to ban staff for any reason at all? Our admin is all about pt satisfaction, so often we just have to deal, but it feels unfair to allow a few pts to dictate the assignments. Or maybe I'm just a jerk. Thoughts? Suggestions?

[Here.I.Stand, BSN, RN]

Do these patients' request also include an all-female provider staff, and is that request accommodated?

My understanding, at least with the big population I work with, is that they do prefer female OB providers -- specifically CNMs.

If they need neurology or ENT, not so much.

It probably has everything to do with the personal/intimate nature of nursing and OB care, vs. other medical care.

In Epic where I work though, when requesting an interpreter for their language, we have the option to specify a female interpreter

[klone, MSN, RN]

Do these patients' request also include an all-female provider staff, and is that request accommodated?

Yep. As one husband explained (his wife, my patient, did not speak English) - they will take what they can get in an ER or otherwise emergent situation, but whenever possible, they want all females, including physicians/CNMs.

[Susie2310]

I think much depends on cultural experiences and previous experience.

I think that often, when women choose male physicians to be their PCP, OB, or other specialty physician, they have often carefully selected that physician - after a certain amount of time the male physician has gained their trust, professionally and personally, and the woman continues in the professional relationship with that physician. The woman has had time to decide whether or not to accept the individual male physician as her physician, and has made the choice to establish the relationship. Some women are not comfortable with receiving nursing care, whether of a more general kind or more intimate procedures, such as foley catheter insertion, from a random male nurse they have only just met and whom they have not personally vetted and chosen to be their health care giver.

[TheGooch]

Nursing care is centered on the patient, not on the nurse's convenience.

Or a nurse's hurt feelings because a patient refused care from them.

[Susie2310]

OP, keep in mind too that statistics show that many more women are physically/sexually abused by men than vice versa. And this is the tip of the iceberg; the majority of abuse is not even reported. Many women have very good reasons for not wishing to incur the attention of a man they do not know and trust, and this can include receiving health care from strange men (male nurses/physicians/etc.).

[Mandychelle79, ASN, RN]

I have had male patients refuse to abide by rules/ redirections (psych) because it was an all female staff working. I believe the quote was I am a grown *** man I am not listening to a woman.

[Rose_Queen, BSN, MSN, RN]

Do these patients' request also include an all-female provider staff, and is that request accommodated?

Of the one OR patient I've had that requested an all female surgical team, yes. This patient traveled a pretty decent distance in order to have a female surgeon in the necessary specialty, a female anesthesia provider, and an all female team. Patient was devout Muslim.

[imintrouble, BSN, RN]

I'm conflicted. I absolutely understand some female objections to male caregivers. But then I think where does it end?

Nurse/ patient interactions are already heavily tilted toward the patient. What I think, what I believe, what I feel does not matter one bit if it conflicts with what the patient wants.

I understand the patient comes first. But in all things? All the time? They don't have to compromise ever?

I think my problem is I remember when special requests were the exception, instead of the rule.

[Ruby Vee, BSN]

Okay, I'll try this again (cut and pasted from the other thread)

I work for a facility that sees a very high percentage of immigrants, including northern Africa and Middle Eastern countries. Many of these women are devout Muslim, or Orthodox Jew, and request no male care providers. Because we try to give culturally sensitive care, we accommodate them whenever we can.

Same with a nurse being "fired" by a patient. We're not going to put that nurse with the patient again, both for the sake of the patient as well as that of the nurse. I certainly don't want to take care of a patient who doesn't want me there!

I can understand accomodating these requests when possible -- but if there are only 4 nurses on a shift and two are male, it may not be possible. In that case, we cannot do the "culturally sensitive care" these folks are asking for and THEY have to be culturally sensitive enough to accept that they are in the US, theirs is not the predominate culture and they may have to make accomodations for US.

[Pranqster]

I'm biting my tongue here because patients do have the absolute right to refuse care for whatever reason, BUT its impossible to move towards an equal society if we treat "preferences" as anything other than sexism, racism, homophobia, etc. The practice should be frowned upon unashamedly.

[DowntheRiver]

I work with a population that also often refuses male nurses, oddly they like their Physicians to be male and will even refuse female physicians.

I was just thinking the same thing! This used to happen all the time at my old facility. They'd want a male doctor/OB but for a nurse they'd refuse a man. What is sad is that at my old facility we had a male nurse that could literally run circles around me (being a new grad) yet I'd have to take assignments because these ladies didn't want him as their nurse.

[Rose_Queen, BSN, MSN, RN]

I'm biting my tongue here because patients do have the absolute right to refuse care for whatever reason, BUT its impossible to move towards an equal society if we treat "preferences" as anything other than sexism, racism, homophobia, etc. The practice should be frowned upon unashamedly.

I don't see it as impeding a move toward an equal society but rather as a respect for others' cultures and experiences. The reasons behind the request can be myriad- as a survivor of sexual abuse, I can tell you that for procedures involving intimate areas, I would definitely prefer a female provider, even though as a nurse and logically I know there is nothing at all sexual about the interaction.